Critics Challenge $22 Billion Cost Estimate for No Surprises Act Arbitration
Radiology Partners executives argue that a recent Health Affairs analysis overstates the costs of the No Surprises Act's arbitration process by ignoring savings from lower in-network rates and reduced out-of-pocket payments. They contend the $22.4 billion figure includes $15.6 billion in payment amounts above the qualifying payment amount, but fails to account for the law's patient-protective benefits and CBO-projected savings.
The QPA is calculated by insurers using a 2019 median in-network rate adjusted for inflation, but critics argue it lacks transparency and often falls below actual median rates. A federal appeals court recently invalidated parts of the calculation methodology, noting insurers could exploit loopholes to depress the figure.
The authors emphasize that the vast majority of claims—76%—are settled at the initial payment level without entering arbitration. Data from late 2025 shows the median initial payment was 90% of the QPA, implying substantial savings from these settled cases are omitted from the cost analysis.
The ongoing dispute over the true cost of the No Surprises Act could shape future regulatory adjustments to the arbitration process. If policymakers accept the higher cost estimate, they may impose stricter caps or fees on arbitration, potentially reducing provider leverage and affecting patient access to out-of-network specialists. Conversely, if the critics' accounting gains traction, the current patient-protective framework may remain largely intact, though administrative burdens on providers and insurers could persist. Patients are the ultimate stakeholders, as any changes could influence their out-of-pocket expenses and network choices.